What we measure

How do we know we're doing our job? We use a Plan, Do, Study, Act process to develop programs and projects. This process helps us to measure how well we are taking care of members and how members feel about the services we provide. We use this information
to continually improve.

Health coaching programs

Our health coaching programs support members at all stages of life and health. We review medical and pharmacy claims data to help identify the need for programs, which aim to:

Deliver preventive services that keep members healthy.

Offer the most up-to-date treatments and interventions for acute illness and to help improve members' health.

Maintain a quality care delivery system that helps members with chronic diseases manage their illnesses.

Provide appropriate treatment and testing to members.

Health coach services

Our health coaches guide members through chronic condition management so they feel their best. Participants receive one-on-one support from one of our health coaches by phone or email. Health coaches send reminder mailings, worksheets, workbooks and online
support tools to keep members engaged. For example, participants with diabetes learn why regular exams and lab testing are so important. They also get tips on taking medications correctly.

Member satisfaction with health coaching

We survey members to measure their experience and satisfaction with their health coaching. Our goal is to receive "strongly agree" or "agree" responses from at least 95% of respondents. In 2016, 95.1% of survey participants strongly agreed or agreed with
all positively framed survey statements. Since we met our member experience goal, no program changes were identified as a result of this analysis.

Cardiac Care program

In the U.S., heart disease ranks as the number one cause of death for adults. However, there are many lifestyle changes you can make to reduce your risk and feel better. Our Cardiac Care program offers Moda Health members a chance to take charge of their
health by working with a trained health coach by phone or email. To monitor the effectiveness of this program, in 2016 we measured outcomes for cardiac medication adherence and blood pressure and cholesterol control in members who participated in
our Cardiac Care program.

Cardiac Care program clinical outcomes1

Disease state

Outcome

Members enrolled2 (%)

Comparison group3 (%)

p-value

Cardiac

% members on medicine to help control high cholesterol who filled their prescription more than 80% of the time

88.4%

82.5%

0.0089*

% members on medicine to help control high blood pressure who filled their prescription more than 80% of the time

93.5%

89.3%

0.0042*

1 Based on medical and pharmacy claims

2 Members who engaged in ≥ 2 sessions with a health coach

3 Members who were invited during the same period and did not engage with a health coach

Medication possession ratio (MPR) is the rate at which a member refills medication as prescribed by their provider. Our goal is to achieve a greater than 80% refill rate. We measure MPRs for medicines to help control high cholesterol and to help control
high blood pressure. Members who enrolled in coaching (88.40%) had a higher MPR rate than the comparison population (82.54%). Members enrolled in coaching (93.53%) had a higher rate of meeting the MPR goal for medicine to help control high blood pressure
than the comparison population (89.25%). Since we met our goals for each outcome measure above, no program changes were identified as a result of this analysis.

Diabetes Care program

Living with diabetes can be challenging. You can feel good one day and out of control the next. Our Diabetes Care program is specially created to help members manage their diabetes and keep complications in check. When Moda Health members enroll, they
get free one-on-one access to a health coach. To monitor the effectiveness of this program, in 2016 we measured three clinical outcomes: eye exam rates, hemoglobin A1c screening rates and HbA1c control < 8 percent for members who participated in
the Diabetes Care program.

Diabetes Care program clinical outcomes 1

Disease state

Outcome

Members enrolled2 (%)

Comparison group3 (%)

p-value

Diabetes

Dilated eye exam

69.3%

50.1%

<0.001*

Average blood sugar levels over a period of weeks or months (HbA1c)

26.5%

42.5%

<0.001*

1 Based on medical and pharmacy claims

2 Members who engaged in ≥ 2 sessions with a health coach

3 Members who were invited during the same period and did not engage with a health coach

Moda compares outcomes for members enrolled in health coaching to those members eligible but opting not to join coaching. The goal of these measures is to see the enrolled members with a higher rate than the non-enrolled members. We measured the effectiveness
of our Diabetes Care program by using two measurement guidelines recommended by the American Diabetes Association: an annual dilated eye exam and an annual HbA1c test

The dilated eye exam rate was higher for Moda Health members enrolled in coaching (69.31%) compared with members not enrolled (50.06%). The hemoglobin A1c test rate was lower for Moda Health members enrolled in health coaching (26.46%) compared with those
not enrolled (42.46%). As such, we are looking into new ways to engage members to get appropriate testing completed, as well as how our data collection methodologies may have impacted the A1c rate.

Depression Care program

If members are struggling with depression, we can help. Our Depression Care program allows Moda Health members to work one-on-one, by phone or email, with a health coach who will listen to concerns and help decide on the best care. To monitor the effectiveness
of this program, in 2016 we measured adherence to depression medication and change in the level of depression.

Depression Care program clinical outcomes 1

Disease state

Outcome

Members enrolled2 (%)

Comparison group3 (%)

p-value

Depression

% members on medicine for depression who filled their prescription more than 80% of the time

81.7%

81.8%

0.97*

1 Based on medical and pharmacy claims

2 Members who engaged in ≥ 2 sessions with a health coach

3 Members who were invited during the same period and did not engage with a health coach

Medication possession ratio (MPR) is the rate at which an individual member refills medication as prescribed by their provider. Our goal is to achieve a greater than 80% refill rate. We measure MPRs for medicines to help control depression. The MPR for
antidepressants was about the same for Moda Health members enrolled in coaching (81.71%) and the comparison population (81.80%). Since we met our goal for the outcome measure above, no program changes were identified as a result of this analysis.

Participants in health coaching complete a patient health questionnaire (PHQ-9) at the time of program enrollment to measure the severity of their depression. The PHQ-9 results help clinicians in the diagnosis of depression and in selecting and monitoring
treatment. We re-administer the survey at an interim point and when the member is discharged from the program. Scores can range from zero to 27; the higher the score, the more severe the depression. Our goal is for at least 75% of participants with
clinically significant depression to decrease their PHQ-9 score by at least 50%. We saw slight improvement in 2016 compared with 2015 and will continue to monitor and improve this outcome.